Provider First Line Business Practice Location Address:
4152 KATELLA AVE.
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
LOS ALAMITOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-596-1019
Provider Business Practice Location Address Fax Number:
562-430-5403
Provider Enumeration Date:
07/06/2006